Medicines in syrup, tablet, and capsule form can sometimes have an unpleasant taste, making them difficult for vulnerable patients to swallow. (Image: Imgorthand/Getty Images)
Despite their medicinal properties, most medications have a surprisingly unpleasant taste. From bitter syrups to the lingering metallic aftertaste of some pills, why do so many of our best medications taste so bad? And how much does it even matter?
Most modern drugs were developed from or derived from compounds found in nature, particularly in static species such as plants and marine invertebrates such as sponges and corals.
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Over millions of years, these plants and animals have evolved to produce compounds that interact with different receptors in predator species, whether it be the heart-stopping cardiac glycosides in foxgloves, the hallucinogenic alkaloids in belladonna, or the toxic taxane compounds in yew berries.
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In response, humans (and many other animals) have evolved taste receptors to detect these harmful compounds, with bitter taste serving as a clear signal to avoid these potentially harmful foods. Thus, bitter taste is a warning sign that a certain chemical is likely to alter the body's normal chemistry.
Tens of thousands of years later, modern science has begun to help us understand how these compounds interact with our bodies, allowing us to harness their powerful physiological effects in safe and effective medicines. Relatively few drugs utilize these compounds exactly as they are produced by the body; rare examples include antibiotics like penicillin and painkillers like morphine. Most, however, draw inspiration from the chemical structure of natural products, mimicking their biological activity with a few targeted enhancements.
“A drug must have several characteristics: it must be easy to use, well absorbed, reach its target, and be active,” said Taglialatela Scafati. “Therefore, sometimes this requires modifying the drug's structure.”
However, according to Bahija Raimi-Abraham, a pharmaceutical scientist and practicing pharmacist at King's College London, when looking at medicines, it is important to distinguish between the active drug compound and the dosage form that the patient actually takes.
In the medicine that the patient receives, the active ingredient is combined with biologically inactive components, known as excipients, which regulate properties of the drug such as absorption and stability, and also allow the drug to be processed into syrups, tablets and capsules that are convenient for consumption.
In theory, adding flavoring excipients should help combat the unpleasant taste of the active ingredient in tablets and syrups. But, as Raimi-Abraham told Live Science, patient perception of medications is actually much more complex than just taste. “People pay a lot of attention to taste, but we should focus on palatability,” she explained. “We don't just think about taste; we think about smell, we think about aftertaste, texture, appearance. These factors determine whether a person will accept a medication.”
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This is especially important to consider when working with children and elderly patients: if a medication tastes unpleasant, there is a real risk that children and elderly patients will refuse (or have difficulty) taking the required dose. Not only does this potentially threaten the health of more vulnerable patients, but failure to complete the prescribed course of treatment can contribute to the wider spread of drug resistance, particularly to antibiotics.
Therefore, achieving a balance between the various aspects of taste is extremely important, but incredibly difficult. Improving one factor can often negatively impact another, and this is partly due to the physical mechanism of taste perception in the human body.
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“The primary taste buds we know of are on the tongue, but taste buds are also found in other parts of the body, including the esophagus and stomach,” Raimi-Abraham said. Therefore, a flavored formula designed to mask bitterness in the mouth can leave an unpleasant aftertaste after the active ingredient dissolves in the stomach.
Despite these challenges, pharmaceutical companies invest millions of dollars annually in attempts to address taste issues. “There are many different strategies: sweeteners and flavors, coatings, altering the chemical structure, adding modifiers to alter mouthfeel and mask bitterness. And all of this takes into account patient characteristics, such as age, which affects taste,” said Raimi-Abraham. “I think the reason some medications are still bitter is because finding the right formulation strategy to achieve overall taste is as much an art as a science.”
Victoria Atkinson, Social Links Navigator, Live Science Contributor
Victoria Atkinson is a freelance science journalist specializing in chemistry and its interactions with the natural and built worlds. She currently lives in York, UK. Previously, she worked as a science content developer at the University of Oxford and then on the editorial board of Chemistry World magazine. Since becoming a freelancer, Victoria has expanded her work to cover topics across various scientific fields and has collaborated with Chemistry Review, Neon Squid Publishing, and the Open University, among others. She holds a PhD in organic chemistry from the University of Oxford.
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